Anti-skid surgical instrument for use in preparing holes in bone tissue

ABSTRACT

Described herein is an anti-skid surgical instrument for use in preparing holes in bone tissue. The disclosed surgical instrument provides the ability to prepare a precise hole in bone tissue during surgery (e.g., spinal surgeries and pedicle screw placement, intramedullary screw placement). The disclosed surgical instrument accomplishes precise hole placement regardless of whether the angle between the drill axis and surface of the bone tissue is perpendicular. The disclosed technology includes a flat drilling surface which is perpendicular to the surface of the body of the surgical instrument. This reduces the likelihood of the surgical instrument skidding on the surface of the bone tissue and thereby increases the precision of the hole.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 15/405,743 filed on Jan. 13, 2017 (published asU.S. Pat. Pub. No. 2017-0224358), which claims priority to U.S.Provisional Patent Application No. 62/278,313, filed Jan. 13, 2016,entitled “Anti-Skid Surgical Instrument for use in Preparing Holes inBone Tissue” (expired) and U.S. Provisional Patent Application No.62/395,795, filed Sep. 16, 2016, entitled “Anti-Skid Surgical Instrumentfor use in Preparing Holes in Bone Tissue” (expired).

U.S. patent application Ser. No. 15/405,743 is a Continuation-in-Part ofU.S. patent application Ser. No. 14/799,170, filed Jul. 14, 2015,entitled “Anti-Skid Surgical Instrument for use in Preparing Holes inBone Tissue,” (now U.S. Pat. No. 10,357,257), which claims priority toU.S. Provisional Patent Application No. 62/024,402, filed Jul. 14, 2014,entitled “Anti-Skid Surgical Instrument for use in Preparing Holes inBone Tissue,” (expired), the contents of all of which which areincorporated by reference herein in their entireties.

FIELD OF THE DISCLOSURE

The present invention relates to an anti-skid surgical instrument foruse in preparing holes in bone tissue during an operation.

BACKGROUND INFORMATION

Spinal surgeries often require precision drilling and placement ofscrews or other implements in bone tissue. Catastrophic damage or deathmay result from improper drilling or maneuvering of the body duringspinal surgery due to the proximity of the spinal cord and arteries.Further, accurate placement is typically necessary for a successfuloutcome. For example, spinal fusion is typically augmented bystabilizing the vertebrae with fixation devices, such as metallicscrews, rods, and plates, to facilitate bone fusion. In spinal fusion,as well as other surgeries, the accuracy with which the screws areplaced in the bone has a direct effect on the outcome of the procedure.The less motion there is between the two bones trying to heal, thehigher the change the bones will successfully fuse. The use of fixationdevices has increased the success rate of spinal fusion proceduresconsiderably.

Such procedures rely strongly on the expertise of the surgeon, and thereis significant variation in success rate among different surgeons. Anumber of navigational and verification approaches have been developed.However, screw misplacement is still a common problem in such surgicalprocedures. Screws may be misaligned due to inaccurate holes drilledprior to inserting the screw. The angle of the tip of the drill maycause the drill bit to skid as the tip contacts the bone tissue, therebycausing the hole to be drilled along an incorrect trajectory. Typically,unless a bone drill is driven at 90 degrees to the bone surface there isa tendency for the drill bit to skid over the bone surface therebyplacing the hole inappropriately. Thus, there is a need for an anti-skidsurgical instrument for preparing holes in a patient's bone whileminimizing the risk of the instrument skidding upon contact of thesurgical instrument with the bone.

SUMMARY OF EXEMPLARY EMBODIMENTS OF THE PRESENT DISCLOSURE

Described herein is an anti-skid surgical instrument for use inpreparing holes in bone tissue. The disclosed surgical instrumentprovides the ability to prepare a precise hole in bone tissue duringsurgery (e.g., spinal surgeries and pedicle screw placement,intramedullary screw placement). The disclosed surgical instrumentaccomplishes precise hole placement regardless of whether the anglebetween the drill axis and surface of the bone tissue is perpendicular.The disclosed technology includes a flat drilling surface which isperpendicular to the surface of the body of the surgical instrument.This reduces the likelihood of the surgical instrument skidding on thesurface of the bone tissue and thereby increases the precision of thehole.

In one aspect, the disclosed technology includes a robotic surgicalsystem for preparing a hole in bone tissue of a patient during surgery,including: a robotic arm having an end effector with a surgicalinstrument guide attached thereto, the surgical instrument guidearranged to hold and/or restrict movement of an anti-skid surgicalinstrument therethrough; and the anti-skid surgical instrument having anelongate structure comprising: a mill head at the end of the elongatestructure for removing bone tissue with reduced skidding (e.g.,unintentional lateral movement of the surgical instrument) of thesurgical instrument upon contact of the anti-ski surgical instrumentwith the bone tissue, wherein the mill head has a flat end substantiallyperpendicular to a longitudinal axis of the elongate structure, and oneor more side-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a spike extending from the millhead; a shank for connection to a drill; and a shaft between the millhead and the shank, the shaft having one or more drill flutes (e.g.,non-cutting flutes) for evacuating removed bone tissue.

In certain embodiments, the mill head comprises a concave face fromwhich the spike extends.

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the system comprises a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In another aspect, the disclosed technology includes a robotic surgicalsystem for preparing a hole in bone tissue of a patient during surgery,including: a robotic arm having an end effector with a surgicalinstrument guide attached thereto, the surgical instrument guidearranged to hold and/or restrict movement of an anti-skid surgicalinstrument therethrough; and the anti-skid surgical instrument having anelongate structure comprising: a mill head at the end of the elongatestructure for removing bone tissue with reduced skidding (e.g.,unintentional lateral movement of the surgical instrument) of thesurgical instrument upon contact of the anti-ski surgical instrumentwith the bone tissue, wherein the mill head has a concave endsubstantially perpendicular to a longitudinal axis of the elongatestructure, and one or more side-cutting flutes about the longitudinalaxis of the elongate structure for cutting into bone tissue; a shank forconnection to a drill; and a shaft between the mill head and the shank,the shaft having one or more drill flutes (e.g., non-cutting flutes) forevacuating removed bone tissue.

In certain embodiments, the instrument includes a spike extending fromthe concave end of the mill head.

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the system comprises a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In another aspect, the disclosed technology includes a robotic surgicalsystem for preparing a hole in bone tissue of a patient during surgery,including: a robotic arm having an end effector with a surgicalinstrument guide attached thereto, the surgical instrument guidearranged to hold and/or restrict movement of an anti-skid surgicalinstrument therethrough; and the anti-skid surgical instrument having anelongate structure comprising: a mill head at the end of the elongatestructure for removing bone tissue with reduced skidding (e.g.,unintentional lateral movement of the surgical instrument) of thesurgical instrument upon contact of the anti-ski surgical instrumentwith the bone tissue, wherein the mill head has a flat end substantiallyperpendicular to a longitudinal axis of the elongate structure, and oneor more side-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; a shaft between the mill head and the shank, the shaft having oneor more drill flutes (e.g., non-cutting flutes) for evacuating removedbone tissue; and a cannulation in the surgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the instrument includes a spike extending fromthe mill head.

In certain embodiments, the mill head includes a concave face (e.g.,from which the spike extends).

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the system comprises a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In another aspect, the disclosed technology includes a robotic surgicalsystem for preparing a hole in bone tissue of a patient during surgery,comprising:

a robotic arm having an end effector with a surgical instrument guideattached thereto, the surgical instrument guide arranged to hold and/orrestrict movement of an anti-skid surgical instrument therethrough; andthe anti-skid surgical instrument having an elongate structurecomprising: a mill head at the end of the elongate structure forremoving bone tissue with reduced skidding (e.g., unintentional lateralmovement of the surgical instrument) of the surgical instrument uponcontact of the anti-ski surgical instrument with the bone tissue,wherein the mill head has a flat end substantially perpendicular to alongitudinal axis of the elongate structure, and one or moreside-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; a shaft between the mill head and the shank, the shaft having oneor more drill flutes (e.g., non-cutting flutes) for evacuating removedbone tissue; and a compliant part that absorbs energy from the millhead.

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a spike extending fromthe mill head.

In certain embodiments, the mill head comprises a concave face (e.g.,from which the spike extends).

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the system comprises a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In one aspect, the disclosed technology includes a robotic surgicalsystem for preparing a hole in bone tissue of a patient during surgery,including: a robotic arm having an end effector with a surgicalinstrument guide attached thereto, the surgical instrument guidearranged to hold and/or restrict movement of an anti-skid surgicalinstrument therethrough; and the anti-skid surgical instrument having anelongate structure comprising: a mill head at the end of the elongatestructure for removing bone tissue with reduced skidding (e.g.,unintentional lateral movement of the surgical instrument) of thesurgical instrument upon contact of the anti-ski surgical instrumentwith the bone tissue, wherein the mill head has a flat end substantiallyperpendicular to a longitudinal axis of the elongate structure, and oneor more side-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; a shaft between the mill head and the shank, the shaft having oneor more drill flutes (e.g., non-cutting flutes) for evacuating removedbone tissue; and a depth control.

In certain embodiments, the depth control comprises one or moremarkings.

In certain embodiments, the depth control comprises one or more colorsfor depicting depth of insertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a spike extending fromthe mill head.

In certain embodiments, the mill head comprises a concave face (e.g.,from which the spike extends).

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the system comprises a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In another aspect, the disclosed technology includes an anti-skidsurgical instrument for preparing a hole in bone tissue of a patientduring surgery, the anti-skid surgical instrument having an elongatestructure comprising: a mill head at the end of the elongate structurefor removing bone tissue with reduced skidding (e.g., unintentionallateral movement of the surgical instrument) of the surgical instrumentupon contact of the anti-ski surgical instrument with the bone tissue,wherein the mill head has a flat end substantially perpendicular to alongitudinal axis of the elongate structure, and one or moreside-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a spike extending from the millhead; a shank for connection to a drill; and a shaft between the millhead and the shank, the shaft having one or more drill flutes (e.g.,non-cutting flutes) for evacuating removed bone tissue.

In certain embodiments, the mill head comprises a concave face fromwhich the spike extends.

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, the instrument includes a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the instrument includes a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In certain embodiments, the disclosed technology includes an anti-skidsurgical instrument for preparing a hole in bone tissue of a patientduring surgery, the anti-skid surgical instrument having an elongatestructure comprising: a mill head at the end of the elongate structurefor removing bone tissue with reduced skidding (e.g., unintentionallateral movement of the surgical instrument) of the surgical instrumentupon contact of the anti-ski surgical instrument with the bone tissue,wherein the mill head has a concave end substantially perpendicular to alongitudinal axis of the elongate structure, and one or moreside-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; and a shaft between the mill head and the shank, the shaft havingone or more drill flutes (e.g., non-cutting flutes) for evacuatingremoved bone tissue.

In certain embodiments, the instrument includes a spike extending fromthe concave end of the mill head.

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, the instrument includes a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the instrument includes a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In another aspect, the disclosed technology includes an anti-skidsurgical instrument for preparing a hole in bone tissue of a patientduring surgery, the anti-skid surgical instrument having an elongatestructure comprising: a mill head at the end of the elongate structurefor removing bone tissue with reduced skidding (e.g., unintentionallateral movement of the surgical instrument) of the surgical instrumentupon contact of the anti-ski surgical instrument with the bone tissue,wherein the mill head has a flat end substantially perpendicular to alongitudinal axis of the elongate structure, and one or moreside-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; a shaft between the mill head and the shank, the shaft having oneor more drill flutes (e.g., non-cutting flutes) for evacuating removedbone tissue; and a cannulation in the surgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a spike extending fromthe mill head.

In certain embodiments, the mill head comprises a concave face (e.g.,from which the spike extends).

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, the instrument includes a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the instrument includes a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In another aspect, the disclosed technology includes an anti-skidsurgical instrument for preparing a hole in bone tissue of a patientduring surgery, the anti-skid surgical instrument having an elongatestructure comprising: a mill head at the end of the elongate structurefor removing bone tissue with reduced skidding (e.g., unintentionallateral movement of the surgical instrument) of the surgical instrumentupon contact of the anti-ski surgical instrument with the bone tissue,wherein the mill head has a flat end substantially perpendicular to alongitudinal axis of the elongate structure, and one or moreside-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; a shaft between the mill head and the shank, the shaft having oneor more drill flutes (e.g., non-cutting flutes) for evacuating removedbone tissue; and a compliant part that absorbs energy from the millhead.

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, the instrument includes a spike extending fromthe mill head.

In certain embodiments, the mill head comprises a concave face (e.g.,from which the spike extends).

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a depth control.

In certain embodiments, the depth control comprises at least one of oneor more markings and one or more colors for depicting depth ofinsertion.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, the instrument includes a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

In another aspect, the disclosed technology includes an anti-skidsurgical instrument for preparing a hole in bone tissue of a patientduring surgery, the anti-skid surgical instrument having an elongatestructure comprising: a mill head at the end of the elongate structurefor removing bone tissue with reduced skidding (e.g., unintentionallateral movement of the surgical instrument) of the surgical instrumentupon contact of the anti-ski surgical instrument with the bone tissue,wherein the mill head has a flat end substantially perpendicular to alongitudinal axis of the elongate structure, and one or moreside-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; a shaft between the mill head and the shank, the shaft having oneor more drill flutes (e.g., non-cutting flutes) for evacuating removedbone tissue; and a depth control.

In certain embodiments, the depth control comprises one or moremarkings.

In certain embodiments, the depth control comprises one or more colors.

In certain embodiments, the depth control comprises a first portionindicating when to start rotation of the anti-skid surgical instrumentand a second portion indicating when to at least one of stop rotationand stop depth penetration of the anti-ski surgical instrument.

In certain embodiments, the depth control comprises a depth stop thatadjustably attached to the anti-skid surgical instrument such that thedepth of penetration of the anti-skid surgical instrument changes as aposition of the depth stop is changed.

In certain embodiments, the shaft comprises one or more notches and thedepth control engages at least one of the one or more notches whenattached to the anti-skid surgical instrument.

In certain embodiments, instrument includes a spike extending from themill head.

In certain embodiments, the mill head comprises a concave face (e.g.,from which the spike extends).

In certain embodiments, the instrument includes a cannulation in thesurgical instrument.

In certain embodiments, the cannulation comprises a hole in the end ofthe elongate structure (e.g., a tip of the surgical instrument).

In certain embodiments, the instrument includes a compliant part thatabsorbs energy from the mill head.

In certain embodiments, the compliant part comprises at least one of anelastic material, rubber, a bellow, and a universal joint.

In certain embodiments, the compliant part connects a first portion ofthe anti-ski surgical instrument to a second portion of the anti-skidsurgical instrument.

In certain embodiments, the first portion comprises the mill head and aportion of the shaft and the second portion comprises the shank and aportion of the shaft.

In certain embodiments, the compliant part covers at least a portion ofthe shank.

In certain embodiments, the compliant part covers at least part of theshaft.

In certain embodiments, the compliant part covers at least part of theshaft and the shank.

In certain embodiments, the instrument includes a tool support locatedbetween the shaft and the shank, wherein: the tool support is shaped andsized to slide through the surgical instrument guide along the axisdefined by the guide, and a diameter of the tool support is greater thana diameter of the shank.

In certain embodiments, the end of the mill head has one or more endcutting flutes for cutting axially into the bone tissue.

In certain embodiments, the one or more drill flutes comprise at leasttwo, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, one or more side cutting flutes comprise atleast two, three, four, six, eight, ten, or twenty flutes.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the mill head.

In certain embodiments, a longitudinal length of the shaft is greaterthan a longitudinal length of the shank.

In certain embodiments, the one or more drill flutes have a higher twistrate (i.e., larger flute angle) than the one or more side cutting flutesor the one or more drill flutes have a lower twist rate (i.e., smallerflute angle) than the one or more side cutting flutes.

In certain embodiments, the one or more drill flutes have a differenttwist rate (i.e., different flute angle) than the one or more sidecutting flutes.

In certain embodiments, the surgery is spinal, orthopedic, dental, ear,nose, or throat surgery.

In certain embodiments, a manipulator is attached to the robotic arm ormolded into the robotic arm.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, aspects, features, and advantages ofthe present disclosure will become more apparent and better understoodby referring to the following description taken in conjunction with theaccompanying drawings, in which:

FIG. 1 is an illustration of example drill bits for preparing holes inbone tissue;

FIG. 2 is an illustration of example surgical instruments for preparingholes in bone tissue;

FIG. 3 illustrates why a drill bit skiving on the surface vertebrae canbe particularly problematic for abnormal vertebrae (e.g. arthritic);

FIG. 4A and FIG. 4B are still photographs taken during an experimentperformed using the disclosed technology and standard drill bits tomeasure the amount of skiving experienced with different drill bitdesigns;

FIG. 5 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 6 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 7 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 8 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 9 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 10 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 11 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 12 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 13 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 14 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 15 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 16 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 17 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 18 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 19 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 20 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 21 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 22 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 23 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 24 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 25 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 26 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 27 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 28 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 29 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 30 is a still photograph taken during an experiment performed usingthe disclosed technology and standard drill bits to measure the amountof skiving experienced with different drill bit designs;

FIG. 31 illustrates an anti-skive drill bit in accordance withembodiments of the disclosed technology;

FIG. 32A and FIG. 32B illustrate anti-skive drill bits in accordancewith embodiments of the disclosed technology;

FIG. 33A and FIG. 33B illustrate anti-skive drill bits in accordancewith embodiments of the disclosed technology;

FIG. 34 illustrates an anti-skive drill bit in accordance withembodiments of the disclosed technology;

FIG. 35A, FIG. 35B, and FIG. 35C illustrate an anti-skive drill bit inaccordance with embodiments of the disclosed technology;

FIG. 36 illustrates a problem solved by use of a compliant part asdescribed in relation to FIGS. 37A through 39C;

FIG. 37A and FIG. 37B illustrate example compliant parts in accordancewith an embodiment of the invention;

FIG. 38 illustrates an example compliant part in accordance with anembodiment of the invention;

FIG. 39A, FIG. 39B, and FIG. 39C illustrate example compliant parts inaccordance with an embodiment of the invention; and

FIG. 40 is an illustration of cannulated drill bits.

The features and advantages of the present disclosure will become moreapparent from the detailed description set forth below when taken inconjunction with the drawings, in which like reference charactersidentify corresponding elements throughout. In the drawings, likereference numbers generally indicate identical, functionally similar,and/or structurally similar elements.

DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS OF DISCLOSURE

Described herein is an anti-skid surgical instrument for use inpreparing holes in bone tissue. In certain types of surgeries it isnecessary to prepare a precise hole in bone tissue (e.g. spinalsurgeries and pedicle screw placement, intramedullary screw placement);however, in many instances, human anatomy is not well adapted fordrilling in these regions because the angle between the drill axis andsurface of the bone is not perpendicular. The disclosed technologyprovides the ability to precisely prepare a hole in bone tissue byminimizing the likelihood that the surgical instrument skids uponcontact with bone tissue.

As used herein, the phrase “prepare a hole in bone tissue” encompassesmilling, drilling, grinding, and/or cutting bone tissue and/or bone-liketissue. A “hole” encompasses any cavity, dent, or depression.

FIG. 1 is an illustration of example prior art drill bits 102 and 104and an example surgical instrument guide 106. Typically, surgicalinstruments include a tapered end 114 that narrows to a point 116. Thepoint 116 is used to guide the drill bit. Standard surgical instruments,especially drill bits, may skid on the surface of bone tissue whichsignificantly decreases precision of the hole. The skidding can belinked with drill angle a which is not well adapted to drilling at anangle (different from the right angle) to the bone tissue surface. Giventhat the surface of most bones are not perfectly flat, standard drillbits often result in imprecise holes in the bone. For example, if theside of the drill (e.g., the side of the tapered tip 114 of the drill)touches the bone tissue before tip 116 of the drill bit has entered thetissue and provides guidance, drill skid is more likely.

FIG. 2 is a comparison of three drill bits contacting the surface ofbone tissue 208. As shown in FIG. 2 , drill bit 202 is likely to skidbecause the tip 216 a of the drill bit 202 will not contract the surfaceof the bone tissue 208 first. Instead, the side 214 a of the tapered tipwill contract the bone tissue 208 before the tip 216 a. Relative todrill bit 202, the tip 216 b of drill bit 204 is less likely to skidbecause the tip 216 b of the drill bit 204 contracts the bone tissue 208first. However, one of the reasons it is difficult to predict if andwhen a drill bit will skid during surgeries is the difficulty ofdetermining whether the tip of the drill bit will contract the bonetissue 208 first. The anti-skid surgical instrument 206 as shown in FIG.2 reduces the risk of drill bit skid because the “tip” is a flat millingsurface 218 which is perpendicular to the surface of the body of thesurgical instrument. The mill head 210 of the anti-skid surgicalinstrument 206 is adapted for milling (e.g., rather than drilling) whenentering the bone tissue 208. The portion of the instrument body 212after the head 210, in some implementations, is adapted for drilling(e.g., contains evacuating holes, spirals, twists, etc.).

In some implementations, the anti-skid surgical instrument 206 has amill head 210 at the end of the elongate structure for removing bonetissue with reduced skidding (e.g., unintentional lateral movement ofthe surgical instrument) of the surgical instrument upon contact of theanti-ski surgical instrument with the bone tissue 208. The mill head 210has a flat end 218 substantially perpendicular to a longitudinal axis ofthe elongate structure. In some implementations, the mill head 210 hasone or more side-cutting flutes 220 (e.g., sharpened) about thelongitudinal axis of the elongate structure for cutting into bonetissue. The one or more side cutting flutes 220 can include two, three,four, six, eight, ten, or twenty flutes.

In some implementations, the anti-skid surgical instrument 206 has ashank (not shown) for connection to a drill. In some implementations,the anti-skid surgical instrument 206 has a shaft 212 between the millhead 210 and the shank, the shaft 212 having one or more drill flutes224 (e.g., non-cutting flutes; e.g., unsharpened) for evacuating removedbone tissue. In some implementations, the one or more drill flutes 224include two, three, four, six, eight, ten, or twenty flutes. The one ormore drill flutes 224 are different than the one or more side cuttingflutes 220. For example, the drill flutes 224 may have a different(e.g., larger or smaller) twist rate, (e.g., flute angle) than the sidecutting flutes 220.

In some implementations, the flat end 218 of the mill head 210 has oneor more end cutting flutes (not shown) for cutting axially into the bonetissue. In some implementations, the one or more end cutting flutes arecutting teeth. Additionally, a longitudinal length of the shaft, in someimplementations, is greater than a longitudinal length of the mill head.The longitudinal length of the shaft, in some implementations, is lessthan a longitudinal length of the mill head.

As shown in FIG. 2 , the anti-skid surgical instrument 206 has anelongate structure with a mill head 210 with milling surface 218, ashaft 212 with a drill surface. In some implementations, the instrument206 includes a second end, opposite the first end 210, with a shankconfigured to be grasped by a drill. The mill head 210 of the anti-skidsurgical instrument 206 is flat and substantially perpendicular to thesurface of the elongate structure, thereby reducing skidding (e.g.,unintentional lateral movement of the surgical instrument 206) of thesurgical instrument 206 upon contact of the milling surface 218 withbone tissue 208.

The mill end 210, in some implementations, utilizes rotary cutters toremove material. The mill end 210 can take the form of several shapesand sizes. For example, the mill end 210 can be an end mill, slab mill,or other types of milling devices.

The flutes 220 of the mill head 210, in some implementations, are deephelical grooves running up the cutter, while the sharp blade along theedge of the flute 220 is known as the tooth. The tooth cuts thematerial, and chips of this material are pulled up the flute 220 by therotation of the cutter. In some implementations, there is one tooth perflute. In some implementations, there are two or more teeth per flute.For example, the cutter of each flute 220 may have 2, 3, 4, 5, or moreteeth (e.g., 1-4, 5-10, or 10-20 teeth). Typically, the more teeth acutter has, the more rapidly it can remove material. Thus, typically a4-tooth cutter can remove material at twice the rate of a 2-toothcutter. The mill head 210 may be an end mill with cutting teeth at oneend (i.e., the flat end 218) and on the sides 220 of mill end 210. Forexample, the flat end 218 can be a flat bottom cutter.

In some implementations, the surgical instrument 206 is rigidly guided(e.g., by a robotic surgical system). The surgical instrument 206 maycause higher radial forces when entering bone tissue 208, thus a rigidguide ensures that the hole will be placed accurately. The drill usedwith the surgical instrument 206, in some implementations, issufficiently rigid to avoid deflection of the drill itself. A highrotational velocity drill (e.g., power drill) may be used to reduceradial forces.

In certain embodiments, hole placement accuracy is achieved by thecombination of the anti-skid drill bit and the robotic surgical system.The rigidity provided by the robotic surgical system along with theanti-skid drill bit allows precise drilling of holes, thereby minimizing(or eliminating) skiving along the bone upon contact between the boneand the anti-skid drill bit. The robotic surgical system providesrigidity from the floor of the operating room (and/or the surgicaltable) to the surgical instrument itself. This is achieved by eachcomponent within the “chain” providing rigidity. An example surgicalsystem is described in U.S. Pat. No. 9,283,048, filed Apr. 30, 2014 andentitled “Apparatus, Systems, and Methods for Precise Guidance ofSurgical Tools,” the contents of which are hereby incorporated byreference in its entirety. In this example, the mobile cart is designedto rest on legs during surgery such that the robot is fixed in place.Further, the robotic arm is rigidly attached to the base and is anactive arm. Similarly, the notched guide and the surgical instrumentholder are designed to provide rigidity. Examples of notched guides areprovided in U.S. Pat. No. 9,241,771, filed Jan. 15, 2015, entitled“Notched Apparatus for Guidance of an Insertable Instrument along anAxis during Spinal Surgery,” which is hereby incorporated by referencein its entirety. Examples of surgical instrument holders are provided inU.S. Patent Application Publication No. 2015/0305817, filed Apr. 24,2015, entitled “Surgical Instrument Holder for use with a RoboticSurgical System,” which is hereby incorporated by reference in itsentirety. The combination of the notched guide or surgical instrumentholder, active robotic arm, and robot (e.g., robot base), along with theanti-skid drill bit, reduces skidding (e.g., skiving) when the drill bitcontacts the bone, thereby allowing accurate placement of holes forsurgical screws.

In some implementations, the surgical instrument 206 is used incombination with a robotic surgical system, such as the robotic surgicalsystem described in U.S. Pat. No. 9,283,048, filed Apr. 30, 2014 andentitled “Apparatus, Systems, and Methods for Precise Guidance ofSurgical Tools,” the contents of which are hereby incorporated byreference in its entirety.

In some implementations, the surgical instrument 206 is used with apassive arm or any device that provides rigid fixation of the surgicalinstrument 206. The surgical instrument 206 may be insertable into asurgical instrument guide such that the surgical instrument 206 isconstrained by the surgical instrument guide. The surgical instrumentguide may include a rigid hollow tubular structure having a first openend and a second open end. The structure of the guide may define theaxis along which movement of a surgical instrument sliding through thestructure is restricted. The tubular structure may have an interiorsurface shaped and sized to accommodate the anti-skid surgicalinstrument 206 sliding through the guide such that movement of thesurgical instrument 206 (e.g., fitted with a tool support) isconstrained in all directions except along the axis defined by theguide. The surgical instrument 206 may be fitted with or have anintegrated tool support such that the tool support engages the guide toprovide accurate guidance of the surgical instrument 206. For example,the anti-skid surgical instrument 206 may be fitted with a tool supportshaped and sized to slide through the surgical instrument guide alongthe axis defined by the guide.

In instances in which the surgical instrument 206 is guided by a roboticsurgical system, the robotic surgical system may include a robotic arm.In some implementations, the robotic arm has an end effector including asurgical instrument guide attached thereto, the surgical instrumentguide configured to hold and/or restrict movement of a surgicalinstrument therethrough. A navigation marker may be used to track thesurgical instrument 206. The axis of the surgical instrument guide canbe aligned with the desired trajectory in relation to the patientsituation via the manipulator.

FIG. 3 illustrates why drill bit skiving on the surface vertebrae can beparticularly problematic for abnormal vertebrae (e.g. arthritic). On theleft side of the image, a “normal” vertebra is shown with standardtrajectory A going through a pedicle. In this case entry point EA islocated where surface of the bone is close to being perpendicular todrilling axis. This decreases the possibility of skiving.

In contrast, situation on the right side of the image shows an arthriticvertebrae (e.g., of an older person). Due to additional hard bonytissue, facet joint increases its volume and interferes with thetrajectory. It places ideal entry point EB on the angled surface andincreases chances of skiving. If skiving occurs, it will likely displaceentry point to EB1. Instead of the trajectory being trajectory B, itlikely will be trajectory B1 and might lead to screw implant going outof the pedicle. This can result in serious clinical consequences(neurologic, vascular, etc.) for the patient. It should be noted that inmost operated patients arthritis appears at various levels ofadvancement (e.g., healthy patients would have surgery principally as aresult of trauma only).

FIGS. 4A through 30 are still photographs taken during an experimentperformed using the disclosed technology and standard drill bits tomeasure the amount of skiving experienced with different drill bitdesigns. As discussed above, a problem with drilling bone withtraditional drill bits is drill skiving on the surface of the bone(e.g., vertebrae). The test setup is shown in FIGS. 4A-4B. A robot and adrill guide were used to drill holes in simulated patient anatomy. Anexample robot that can be used with the disclosed technology isdescribed in U.S. Pat. No. 9,283,048, filed Apr. 30, 2014 and entitled“Apparatus, Systems, and Methods for Precise Guidance of SurgicalTools,” which is hereby incorporated by reference in its entirety. Thepatient's anatomy was simulated by a custom-made spine simulator whichintegrates bony tissue and foam representing soft tissue to provide amodel with sufficient vertebrae mechanical behavior (resistance,elasticity, bone quality, etc.).

FIG. 5 is a photograph of different types of drill bits tested duringthis experiment. An anti-skid drill-bit in accordance with the disclosedtechnology is shown as drill bit 502. It comprises a body similar to astandard drill bit and a flat end (rather than a pointy end) inaccordance with an embodiment of the invention. Drill bit 504 (e.g.,Drill Bit for Universal Drill Bit Guide by Medtronic of Minneapolis,Minn.) and drill bit 506 (e.g., Vertex® Max Drill Bit by Medtronic ofMinneapolis, Minn.) are commercially available drill bits.

FIGS. 6 through 30 a images from a series of drilling movies capturedduring the experiment. Recording was done using a high-frequency camera(128 fps) for greater precision. The visible ruler in the backgroundallowed for estimating displacements of various elements. All drillingwas done by the surgeon. Trajectories were planned in the way thatemphasizes possible skiving situations while being clinically relevant.Such situations are: angles surface (i.e. not perpendicular to the drillbit axis), on the bone edge, close to other existing hole.

FIGS. 6 through 15 are images captured during experiments conducted withdrill bit 504. Experiments with drill bit 504 (a standard drill bitrepresented by a small diameter, sharp drill bit) illustrated no skivingif drill bit is perpendicular to the drilled surface. However, there wassignificant skiving (+5 mm) on angled surfaces which can lead toimprecise drilled holes and extra-pedicular holes (i.e., holes outsidepedicle either medial (spinal canal, can lead to paralysis) or lateral(vascular system, can lead to death)).

FIGS. 16 through 25 are images captured during experiments conductedwith drill bit 502 (flat head, big diameter) which was constructed inaccordance with an embodiment of this invention. Experiments withanti-skiving drill bit 502 illustrated acceptable skiving (≤1 mm) indrilling to all surfaces (perpendicular and angled). Experiments showedthat the anti-skive drill bit 502 can drill in proximity of previousholes without falling into them and the bit 502 can jitter on the flatsurface before penetrating into bone (i.e., ski before penetrating intobone). With optimized drill bit shape (e.g., the drill bit shown in FIG.32A or FIG. 32B), the performance of this function shall improve.

FIGS. 26 through 30 are images captured during experiments conductedwith drill bit 506 (represented by Vertex Max drill bit in theexperiment). Experiments with anti-skiving drill bit 506 found lessskiving than for standard drill bit 504, but greater skiving than theanti-skiving drill bit 502. Additionally, the drill bit transmittedhigher forces to the vertebrae. Thus, as shown in the experiments, thedisclosed technology provides drill bits that reduce or eliminateunwanted skiving to less than conventional drill bits.

FIGS. 31 through 35C illustrate anti-skive drill bits in accordance withembodiments of the disclosed technology. In certain embodiments, asillustrated in FIG. 31 , a drill bit 3100 in accordance with anembodiment of the disclosed technology includes a drilling part 3102 forcreating a hole and evacuate material as the hole is created, a guidingpart 3104 that interacts with a guide (e.g., held by a robot), and anattachment part 3106 (e.g., a shank) that can be inserted into and/orsecurely held by a drill. As discussed above, the drill bit 3100 has amilling head 3108.

In certain embodiments, as shown in FIGS. 32A and 32B, the drilling part3102 has flutes 3202 along the side of the body. These flutes 3202evacuate material as a hole is drilled. The front face 3210 may be flatand/or have front-cutting surfaces 3210. Additionally, a portion of thebody 3108 between the front face and the flutes can have side-cuttingsurfaces (e.g., milling faces). An alternative front face deviceincludes a concave shape 3212 with a spike 3214 to better guide on flatfaces of bone. The spike 3214, in this embodiment, is centered on thefront face.

In certain embodiments, as shown in FIGS. 33A and 33B, the drill bitincludes a guiding part 3104 that interacts with a guide (e.g., held bya robot). The guiding part 3104 is sized to fit into a guide without anadapter. The guiding part 3104 may consisting of a single cylindricalbody 3302 as shown in FIG. 33A along the length of the drill bit thathas a diameter to fit into a guide. In an alternative embodiment, theguiding part includes two cylindrical parts 3304 as shown in FIG. 33B,each with a diameter to fit into a guide. The two guiding parts areseparated by a portion of the drill bit body extending therebetween witha smaller diameter than the guiding parts.

In certain embodiments, as shown in FIG. 34 , between the drillattachment part 3106 of the drill bit and the guide part 3104 of thedrill bit, the body of the drill bit has markings 3402 a-b to assist auser in preparing holes in a bone. The markings 3402 a-b can be notches,colorings, bands, or other indicators. The marking 3402 a indicates whento start drill rotation (e.g., before contact with bone). An additionalmarking 3402 b indicates when to stop drill rotation and/or stop depthpenetration in the bone. The top side of the marking 3402 a can indicatewhen the drill bit will begin exiting the guide. In certain embodiments,depth control can include a separate depth controller 3506 that attachesto the drill bit 3502 as shown in FIG. 35A, FIG. 35B, and FIG. 35C. Thedepth controller 3506 can sit on one or more notches 3508 on the drillbit 3502 and be tightened to control the depth the drill bit 3502 willextend beyond drill bit guide 3604, thereby controlling the depth ofpenetration in the patient.

FIG. 36 illustrates a set-up for describing the problem solved by acompliant part as described in relation to FIGS. 37A through 39C. Adrill guide is held by the robot represented by robot attachment. Adrill bit is fixed to the surgical drill which gives drill bit rotation.Typically the surgical drill is hand held by the surgeon. A surgeoninserts drill bit into guide and drills hole in patient anatomy/bone(could be any bone, including vertebrae, cranial, and/or standardorthopedic surgery).

A surgical drill can have significant weight (e.g., a few kilogramseven) which makes gravitation force G shown in FIG. 36 high.Additionally, drill rotation as well as forces applied by surgeon giveforces FL. These forces generate high reactions at the robot attachmentrepresented by reaction force R and torque TR. These high reactions puthigh load on robot part and guided instruments. Additionally, they canintroduce imprecisions when guiding. To solve these problems, in certainembodiments, a compliant part (e.g., on or part of the drill bit) isused which allows the insertion movement while transmitting lessreaction forces from the drill and drill bit system to the robot andguide.

FIG. 37A and FIG. 37B are illustrations of portions of drill bits inaccordance with embodiment s of the invention. In this example, thedrill bit includes one or more compliant parts (e.g., made of rubber).In some cases, it is difficult to hold the drill in line with the guide.One or more compliant parts increases the tolerance to these errors. Asshown in FIG. 37A, the compliant part 3706 is used to connect firstportion 3104 of the drill bit to a second portion 3106 of the drill bit.In an alternative embodiment, as shown in FIG. 37B, the compliant part3708 extends around and/or covers at least a portion of the drillattachment part of the drill bit. In certain embodiments, both compliantpart 3706 and compliant part 3708 are used. FIG. 38 illustrates a zone3802 where the compliant part can be placed along the shaft of the drillbit. In certain embodiments, the compliant part can be located on thedrill bit shaft and/or on the interface between drill bit and surgicaldrill.

FIG. 39A, FIG. 39B, and FIG. 39C illustrate various embodiments of adrill bit that includes a compliant part. The embodiment shown in FIG.39A uses a compliant part made of elastic material, such as rubber. Theembodiment shown in FIG. 39B uses a bellow as the compliant part, suchas a metal bellow, is used to provide compliance. The embodiment shownin FIG. 39C uses a standard universal joint is used to allow forcompliance.

FIG. 40 is an illustration of cannulated drill bits 4002 a and 4002 b.In certain embodiments, the drill bits disclosed herein are cannulated.In certain cases, surgeons prefer to use k-wires to provide guidancebetween various stages of the surgery. An example workflow is describedin relation to, for example, FIG. 2A, FIG. 2B and FIG. 9A of U.S. PatentApplication Publication No. 2016/0235492, filed Feb. 18, 2016, entitled“Systems and Methods for Performing Minimally Invasive Spinal Surgerywith a Robotic Surgical System using a Percutaneous Technique”, thecontents of which are hereby incorporated by reference in theirentirety. To implement such workflow, a cannulation 4004 a, 4004 b(i.e., a throughput hole adapted to the size of the k-wire, also calledguide wire) can be created in the drill bit 4002 a, 4002 b.

In view of the structure, functions and apparatus of the systems andmethods described here, in some implementations, a system and method forperforming surgery with a robotic surgical system are provided. Havingdescribed certain implementations of methods and apparatus forsupporting a robotic surgical system, it will now become apparent to oneof skill in the art that other implementations incorporating theconcepts of the disclosure may be used. Therefore, the disclosure shouldnot be limited to certain implementations, but rather should be limitedonly by the spirit and scope of the following claims.

Throughout the description, where apparatus and systems are described ashaving, including, or comprising specific components, or where processesand methods are described as having, including, or comprising specificsteps, it is contemplated that, additionally, there are apparatus, andsystems of the disclosed technology that consist essentially of, orconsist of, the recited components, and that there are processes andmethods according to the disclosed technology that consist essentiallyof, or consist of, the recited processing steps.

It should be understood that the order of steps or order for performingcertain action is immaterial so long as the disclosed technology remainsoperable. Moreover, two or more steps or actions may be conductedsimultaneously.

What is claimed is:
 1. A robotic surgical system for preparing a hole inbone tissue of a patient during surgery, comprising: a robotic armhaving an end effector with a surgical instrument guide attachedthereto, the surgical instrument guide arranged to hold and/or restrictmovement of an anti-skid surgical instrument therethrough; and theanti-skid surgical instrument having an elongate structure comprising: amill head at the end of the elongate structure for removing bone tissuewith reduced skidding of the surgical instrument upon contact of theanti-ski surgical instrument with the bone tissue, wherein the mill headhas one or more side-cutting flutes about the longitudinal axis of theelongate structure for cutting into bone tissue; a spike extending fromthe mill head; a shank for connection to a drill; and a shaft disposedbetween the mill head and the shank, the shaft having one or more drillflutes for evacuating removed bone tissue.
 2. The robotic surgicalsystem of claim 1, wherein the mill head comprises a concave face fromwhich the spike extends.
 3. The robotic surgical system of claim 1,wherein the mill head includes a concave distal face and the spikeextends from the concave distal face.
 4. A robotic surgical system forpreparing a hole in bone tissue of a patient during surgery, comprising:a robotic arm having an end effector with a surgical instrument guideattached thereto, the surgical instrument guide arranged to hold and/orrestrict movement of an anti-skid surgical instrument therethrough; andthe anti-skid surgical instrument having an elongate structurecomprising: a mill head at the end of the elongate structure forremoving bone tissue with reduced skidding of the surgical instrumentupon contact of the anti-ski surgical instrument with the bone tissue,wherein the mill head has a flat end substantially perpendicular to alongitudinal axis of the elongate structure, and one or moreside-cutting flutes about the longitudinal axis of the elongatestructure for cutting into bone tissue; a shank for connection to adrill; a shaft disposed between the mill head and the shank, the shafthaving one or more drill flutes for evacuating removed bone tissue; anda compliant part that absorbs energy from the mill head.
 5. The roboticsurgical system of claim 4, wherein the compliant part comprises atleast one of an elastic material, rubber, a bellow, and a universaljoint.
 6. The robotic surgical system of claim 4, wherein the compliantpart connects a first portion of the anti-ski surgical instrument to asecond portion of the anti-skid surgical instrument.
 7. The roboticsurgical system of claim 4, wherein the first portion comprises the millhead and a portion of the shaft and the second portion comprises theshank and a portion of the shaft.
 8. The robotic surgical system ofclaim 4, wherein the compliant part covers at least a portion of theshank.
 9. The robotic surgical system of claim 4, wherein the compliantpart covers at least part of the shaft.
 10. The robotic surgical systemof claim 4, wherein the compliant part covers at least part of the shaftand the shank.
 11. A robotic surgical system for preparing a hole inbone tissue of a patient during surgery, comprising: a robotic armhaving an end effector with a surgical instrument guide attachedthereto, the surgical instrument guide arranged to hold and/or restrictmovement of an anti-skid surgical instrument therethrough; and theanti-skid surgical instrument having an elongate structure comprising: amill head at the end of the elongate structure for removing bone tissuewith reduced skidding of the surgical instrument upon contact of theanti-ski surgical instrument with the bone tissue, wherein the mill headhas a flat end substantially perpendicular to a longitudinal axis of theelongate structure, and one or more side-cutting flutes about thelongitudinal axis of the elongate structure for cutting into bonetissue; a shank for connection to a drill; a shaft disposed between themill head and the shank, the shaft having one or more drill flutes forevacuating removed bone tissue; and a depth control adapted to beattached to the shaft, wherein the shaft comprises one or more notchesand the depth control is adapted to engage at least one of the one ormore notches when attached to the anti-skid surgical instrument.
 12. Therobotic surgical system of claim 11, wherein the depth control comprisesone or more markings.
 13. The robotic surgical system of claim 11,wherein the depth control comprises one or more colors for depictingdepth of insertion.
 14. The robotic surgical system of claim 11, whereinthe depth control comprises a depth stop that adjustably attached to theanti-skid surgical instrument such that the depth of penetration of theanti-skid surgical instrument changes as a position of the depth stop ischanged.
 15. The robotic surgical system of claim 11, comprising: aspike extending from the mill head.